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Three patients developed facial dermatitis after contact with preparations containing estradiol benzoate. Patch tests were positive to estradiol benzoate 0.1% in MEK but negative to other related estrogens including estradiol. All three patients also had positive tests to resorcinol monobenzoate and two out of three to balsam of Peru. Most likely estradiol benzoate was the primary sensitizer.
Improvement was seen in the dermatitis of 262 of 675 patients who followed a restrictive diet for approximately 1 month. Patients included in the study were sensitive to metal salts, balsams or classical food allergens or reacted to oral challenge with food additives. Also included were patients who did not react to diagnostic tests but who experienced improvement of their dermatitis while maintaining an elimination diet. A follow-up study was carried out 1-3 years after diet treatment was instituted. Each of the 262 patients was asked to complete a questionnaire to describe the long-term course of the dermatitis. 206 responded to the questionnaire, and for 144 of them (70%; 95% confidence limits 64-76%), there was long-term improvement of the dermatitis. Long-term improvement was more common among atopic patients than among non-atopics. Symptoms of contact urticaria were more common among patients with hand eczema than those with other types of eczema.
The possibility for patch testing procedures to detect contact allergy was examined in 85 hospitalized patients with forms of psoriasis. Exclusion criteria were active lesions on the back, the use of strong topical corticosteroids, methotrexate, cyclosporin and UV therapy. After screening, a group of 47 patients with different forms of psoriasis were selected for patch testing. Personal history, including topical treatment, occupation and domestic circumstances, were reasons to extend the standard series of allergens. Tars, nickel sulfate, perfume and balsam of Peru scored high. The overall positive rate was 68%. This is higher than that observed in earlier studies. The unexpected results are discussed in the light of the possible mechanism of action.
We tested the hypothesis that topical adenosine monophosphate phosphodiesterase (cAMP PDE) inhibitors are anti-inflammatory. These can be shown by a correlation between PDE inhibitory and anti-inflammatory function of a series of known PDE inhibitors. The effect of various cAMP PDE inhibitors on PDEs isolated from HaCaT cells was first investigated. These compounds were then tested as anti-irritants against topical 8% Balsam of Peru. A direct correlation was observed between the in vitro EC(50) values for PDE inhibition and the in vivo anti-inflammatory potential with a correlation coefficient of r = 0.79. These results stress the value of PDE inhibitors as anti-inflammatory agents in topical use, and also demonstrate that the in vitro PDE assay can be used to predict in vivo anti-inflammatory potential.
Five hundred subjects were patch-tested on the one hand with 25 allergens standard group and on the other hand with selected allergens depending on the occupation and history of each patient. They systematic standard series are responsible for 79 p. 100 of contact allergens. Among them the most frequent sensitizers observed include potassium dichromate, nickel sulfate, cobalt chloride, paraphenylenediamine, propylene-glycol, triethanolamine, balsam of Peru. The selected allergens stand for 21 p. 100 of our cases. These results are compared with those of other countries. The main sensitizers are involved in every case. However a few discrepancies are to be noted: turpentine and mercury do not occupy with us a foremost rank, whereas prophylene-glycol and triethanolamine which, according to our statistics, stand fourth and seventh, are not mentioned elsewhere. Differents factors can partly account for these variations: industrial products are submitted to local influence, as it occurs with turpentine for instance, environmental factors play an important part too and, above all, local industries. Nevertheless, this study brings into relief two facts:--the interesting use of systematic standard series, constantly updated, since they are responsible for 79 p. 100 of contact allergens;--the incidence of each patient's history and occupation on the choice of selected allergens, thanks to which we can put into relief less usual causes, though they should not been overlooked, since they stand for 21 p. 100 of the allergens so far listed.
Contact and systemic contact-type dermatitis reactions to spices such as nutmeg, mace, cardamom, curry, cinnamon, and laurel may be rare but may well be overlooked. In our experience, patch testing with these spices "as is" is very useful; if there is a positive reaction, testing with dilutions is helpful. Scratch-chamber testing often leads to false-positive irritant reactions. As Hjorth and Niinimäki have pointed out, a positive test to balsam of Peru may indicate a spice allergy, but the absence of such a reaction does not rule it out. In all the cases in our experience, the careful drafting of the anamnesis or case history was critical in the diagnosis.
Among the variety of surgical packs described in the literature, zinc oxide-based packs have proved especially useful. Two types still currently used are the zinc oxide-eugenol pack according to Büchs and Walter and the pack modified by Behlke which contains Peruvian balsam in place of eugenol. Of 27 patients who had undergone a periodontal-surgical intervention, 6 were treated with a zinc oxide-eugenol pack, and 21 with a pack modified by Behlke. Clinical and cytological examinations were performed before intervention, at each change of pack (on the 5th, 8th and 14th days after intervention) and 4 weeks after intervention. The comparison of the results obtained shows the superiority of the pack modified by Behlke over the zinc oxide-eugenol pack.
Six patients with contact dermatitis to propolis are reported (3 women, 3 men; mean age 57 years). All three men had eczema on their hands and had acquired their sensitization in the course of bee keeping. The women had been sensitized by propolis contained in ointments of various kinds. Upon patch testing all six patients reacted to propolis and four also to Peruvian balsam. While ten flavonoids were test-negative, a cinnamic acid ester (1.1-dimethylallyl-3',4'-dihydroxy cinnamic acid ester) isolated both from propolis and from poplar buds was positive in two out of three patients; this may be the major allergen.
The authors studied the action of Pneumorel retard tablets in the treatment of chronic bronchitis, comparing 2 groups of 20 patients each, one group was prescribed 1 pneumorel retard tablet in the morning and evening and the other group was treated with a speciality associating proteolytic enzymes and balsamics; the 2 groups also received an antibiotic treatment. The duration of the treatments was 20 days, with controls at entry, 10 days and 20 days later. Pneumorel retard showed to be significantly more active on the criteria studied (cough, dyspnea, expectoration, signs of auscultation) and this more often than not from the 10th day of treatment. Clinical and biological tolerance was perfect concerning the hepatic sphere, gastrointestinal, renal or cardiovascular systems. The convenience of the use of Pneumorel retard is particularly indicated in the thorough long-term treatment of chronic bronchitis, in preventing episodes of over-infection, worsening the disease.
First mentioning the immunological processes of contact dermatoses, the authors study the six contact allergies encountered most frequently by them during the course of 133 cases of leg ulcers which they treated. They consider in detail the allergenic action of the following six substances: lanolin, neomycin, balsam of Peru, paraben, phenylenediamine and benzocaine. They pioneer therapies intended to prevent the risk of sensitization.
A history of respiratory or other allergic symptoms during the Christmas season is occasionally obtained from allergic patients and can be related to exposure to conifers at home or in school. Incidence and mechanism of production of these symptoms were studied. Of 1657 allergic patients, respiratory and skin allergies to conifers occurred in 7%. This seasonal syndrome includes sneezing, wheezing and transitory skin rashes. The majority of patients develop their disease within 24 hours, but 15% experience symptoms after several days' delay. Mould and pollen studies were carried out in 10 test sites before, during and after tree placement in the home. Scrapings from pine and spruce bark yielded large numbers of Penicillium, Epicoccum and Alternaria, but these failed to become airborne. No significant alteration was discovered in the airborne fungi in houses when trees were present. Pollen studies showed release into air of weed, grass and tree pollens while Christmas trees were in the house. Oleoresins of the tree balsam are thought to be the most likely cause of the symptoms designated as Christmas tree allergy.
A previous study of patients with allergic contact dermatitis yielded results which supported the hypothesis that the presence of certain HLA antigens led to a predisposition to allergen-specific reactions and others to multiple contact sensitivity. The present study was performed to test this hypothesis. 129 patients sensitive to one allergen only (either chromium, nickel, formalin or balsam of Peru) and 83 patients sensitive to two or more allergens were HLA typed regarding the A and B loci. A series of 368 persons matched with regard to sex, age and place of residence were used as controls. A tendency towards an association between HLA B7 and contact allergy was observed. No other data confirming the hypothesis mentioned above were obtained. Among 37 patients who also had atopic diathesis a decreased frequency of HLA B7 was found.
More than 50% of patients with dermatitis of the lower legs have a contact allergy. In 60 of our out-patients, the most frequent allergens were found to be balsam of Peru, lanolin and terpentine, followed by benzocaine, p-phenylenediamine, neomycin, oxychinoline, and parabens. Contact sensitization should be chiefly suspected in patients showing resistance to treatment despite apparently adequate therapy, and in those complaining of intolerance to definite topical treatment. Further indices are vesiculation and oozing in the environment of the ulceration, or scattered foci of dermatitis in the face (blepharoedema) or on the hands. The importance of patch testing is emphasized. Suggestions for differential diagnosis and treatment are given.
Comparative results between positive patch tests found during the periods 1968-1974 and 1975-1981 are presented. The number of sensitised patients to nickel, chromate and Peru balsam has significantly increased. On the other hand, the number of turpentine-oil-positive patch tests has strongly decreased. This mirrors the drop in the imported quantities of this product. A schema concerning factors influencing the apparent allergenicity is given.
In a group of 100 patients with ulcus cruris, the incidence of contact allergies was determined. Patch tests were applied with 18 products that might have come into contact with the skin. These products comprised drugs and excipients (preservatives and ointment vehicles) potential ingredients of tapes or of elastic bandages. Peru balsam (14%), wool-wax alcohols (10%), Nestosyl owing to its para-aminobenzoate component (7%), neomycin (5%) and Thyme oil (5%) were the allergens most frequently encountered.
The role of flavouring was studied in eleven children under five years of age suffering from severe atopic dermatitis. In all cases, the dietary questionnaire showed the high daily intake of natural vanilla, vanillin, natural and artificial flavouring. Double-blind oral provocation tests were carried out with balsam of Peru (225 mg), natural vanilla (50 mg), artificial vanillin (12.5 mg). Nine children out of eleven presented eczematous reactions, one a Quincke's oedema. Two challenges remained negative. The eviction of food flavouring agents brought about a clear improvement in six children. The authors point out the risk of increasing consumption of flavouring agents, and bring into question the traditional attitude of considering food flavouring agents as innocuous.
Drug-induced allergic skin reactions of the eczema type may relatively frequently appear as allergic contact eczema or more rarely as "hematogenous contact eczema." In both types of eczema, a positive patch test to one or more allergens is essential for diagnosis. In 1971 and 1972, there were 85 patients with drug-induced eczema reactions (allergic reactions to the ointment bases and preservatives have not been taken into consideration). In 80 cases, topical applications were the contact allergens. The frequent contact allergies to benzocaine and Balsam of Peru seems significant. In 5 isolated cases we saw hematogenous contact eczema due to internal medication, e.g. with antibiotics.
In the IInd Department of Dermatology, Vienna University, 200 patients (143 female, 57 male) suffering from leg ulcers due to chronic venous insufficiency underwent patch testing with routine allergens, vehicles and their ingredients, as well as topical antibiotics. 114 patients (57%) had contact allergy. Balsam of Peru heads the list of allergens with postive reactions in 22%, closely followed by oil/water emulsions such as Drointin (21%), Ultrasicc (20%) and Ung. emulsificans aqu. (15,5%). The causative agents in these preparations were emulsifiers on the one hand (Lanette O, E, N) and preservatives (parabens) on the other hand. In comparison, allergic reactions to water/oil emulsions were less common. The low index of sensitivity to local antibiotics was also surprising. The results of the present study, in accordance with other reports in the literature, underline the need (1) for full label diclosure of cosmetics and topically-applied drugs and (2) for patch-testing every patient suffering from leg ulcers of long duration.